Polycystic ovary syndrome (PCOS) is a hormone disorder that affects women of reproductive age. For many women, PCOS is a concerning diagnosis that can affect fertility and cause a host of unpleasant symptoms. One of the main treatment strategies for PCOS is healthy weight loss. In some cases, women with PCOS pursue weight loss surgery to manage the condition. This article will review PCOS and weight loss and why weight loss surgery is sometimes considered.

PCOS Causes and Symptoms

It is not currently known exactly what causes PCOS, but a number of factors appear to be involved:

• Genetics, having a family member with a genetic predisposition to PCOS can place you at higher risk for the disease.
• Insulin resistance, which is when the body does not respond well to its own insulin. Insulin resistance can cause the body to release large amounts of insulin.
• High levels of male hormones, also known as androgens. All women have small amounts of androgens, but women with PCOS have abnormally high androgen levels. These androgens can cause many of the symptoms associated with the condition.
• Environmental factors, such as toxins or exposures in the womb.

Despite the word “polycystic” in the name, only some women with PCOS develop ovarian cysts. The diagnosis of PCOS includes three criteria, where any two of the following will generally confirm the diagnosis.

• Decrease or absence of menstrual periods.
• High levels of androgens.
• Polycystic ovaries.

The symptoms of PCOS are related to the imbalance of hormones and can include the following:

• Hair growth in unwanted places.
• Acne.
• Thinning of hair.
• Weight gain.

Why Is Weight Loss Recommended in PCOS?

Although the exact cause of PCOS is not clear, the symptoms can be treated by improving sensitivity to insulin. One of the most clear-cut ways to do this is to lose weight.

With each pound lost, the body is able to use its own insulin more effectively. A 5-10% change in weight has been shown to significantly improve measures of insulin resistance.

When insulin resistance improves, the body no longer needs to overcompensate by releasing large amounts of insulin. In turn, this will reduce androgen activity and ultimately reduce PCOS symptoms.

For these reasons, PCOS is closely linked to obesity and weight loss is often the first-line treatment for managing the condition.

Generally, this will involve lifestyle changes including making diet modifications and increasing exercise.

In those with severe obesity, with over 100 pounds of excess weight or a body mass index (BMI) over 35, weight loss surgery may be recommended.

Deciding if Weight Loss Surgery Is the Right Path

Research suggests that bariatric surgery, or weight loss surgery, can help people lose up to 60-80% of their excess weight. This weight loss can reverse insulin resistance and restore metabolic function.

In women with PCOS, studies suggest that ovulation and menstrual cycles return to normal in most women following bariatric surgery.

Most bariatric surgeries are minimally invasive using a surgical technique known as laparoscopy, where only very small incisions are made.

Despite these benefits of PCOS and weight loss surgery, the decision to undergo bariatric surgery should not be taken lightly. Some bariatric procedures are irreversible and there are several lifestyle changes required after surgery, including:

• Having to undergo a liquid diet both before and after surgery.
• Not being able to drink liquids with meals.
• Limiting or abstaining from alcohol.
• Not being able to eat normal portions of food again.
• Limiting your choices when eating out.
• GI side effects such as stomach upset or reflux if not being careful with your diet.

Which Weight Loss Surgery Is Best for PCOS?

There are several types of bariatric surgeries, with the most common procedures being the sleeve gastrectomy and the Roux-en-Y gastric bypass. The main procedures are summarized below.

• Sleeve Gastrectomy: The stomach is reduced to about 15% of its original size and resembles a banana-shaped “sleeve.” The new sleeve stomach restricts the amount of food that can be eaten at one time and makes changes to hormones involved in hunger.
• Roux-en-y Gastric bypass: The stomach is reduced to a small pouch and attached to the middle portion of the small intestine. This procedure changes hunger hormones, greatly reduces the amount of food that can be eaten, and reduces the amount of food that can be absorbed.
• Adjustable Gastric Band: An inflatable band is placed around the top of the stomach where it meets the esophagus, limiting the amount of food entering the stomach and providing increased satiety after meals.
• Biliopancreatic Diversion with Duodenal Switch: The stomach size is reduced and about 60% of the small intestine is bypassed. This significantly reduces the absorption of foods. Similar to the gastric bypass and sleeve, hunger hormones are altered as well.

Considering PCOS and weight loss surgery, there are pros and cons to each procedure with some providing greater weight loss, but increased complications and others being reversible. Ultimately, it is a careful decision that is made between a patient and their doctor.